Cervical Stenosis & C3/C4 Disc Herniation

I am 32 years old and recently suffered a neck injury playing football which left me paralysed for between 5 & 10 minutes. The MRI scans show cervical stenosis and c3/4 disc compression. The paralysis was caused by bruising of the spinal cord which, in turn, was caused by hyperextension of my neck.

6 weeks on I have almost fully recovered and have no noticable pain. I do however have exagerated reflexes and my left side, from ribs down to toe, doesn't respond to pin *****.

I have seen a specialist spinal surgeon and a neurosurgeon who both say I need to undergo surgery, otherwise risk total paralysis or even death (As the area of the spinal chord is above that which controls breathing!), as a result of a minor fall, car crash etc.

The spinal surgeon wants to do a decompression/fusion from the front. The Neuro surgeon wants to to a Laminectomy.

I am extremely scared by the whole situation! Can anyone give me any advice?

Should I have an Operation?
Which Operation?
What quality of life can I expect after?

I can understand what you're going through right now, as I was in that same position some time ago. I'm a bit older than 32 and didn't get paralysed during a football game, but I was told I needed cervical surgery or risk paralysis/death/all that other stuff. Not a good thing to hear, is it? I was told I had stenosis (the spinal canal wasn't large enough for the spinal cord) and it had to be fixed. Unfortunately there is no non-surgical fix for this condition. If you've got stenosis that is placing too much pressure on the cord, it's got to be alleviated through decompression surgery. In my case the compression went on for too long and I ended up with permanent damage to the cord (myelomalacia). You don't want that to happen.

The biggest question I had was what type of surgery was the best to fix the problem? I had seen an orthopaedic spinal surgeon and two neurosurgeons. Two of them were advocating an anterior approach (from the front) and one of the neurosurgeons said a posterior laminectomy was the way to go. After a bit of struggling with the details on both those approaches, I decided on the anterior. I thought that it was the best way to fix the real problem, which in my case was the osteophytes (bone spurs) growing from the vertebrae. I figurged if there is a mechanical problem and it's in the front, that's how it should be fixed. I ended up having a C5 & C6 corpectomy (the removal of the bodies of the C5 & C6 vertebrae, filled in with a length of bone from a bone bank & covered with a plate and a handful of screws - now fused C4 - C7). The issue with the anterior approach is that it involves a fusion. Once you have a fusion, there will be additional stress placed on the adjacent joints above and below the fusion. If there are any problems at those points, the additional pressure may cause them to fail more quickly than if there were no fusion.

This is what happened to me - I had issues at C3 - C4 which weren't touched in the first surgery. The myelopathy returned (that's the result of the stenosis and pressure on the cord) and I then had a C3/C4/C5 laminaplasty (that's similar to a laminectomy, as it's a posterior approach but the lamina are not removed but just hinged open to make more room for the cord). Although this is not a fusion, I now have less range of movement than before. So I know the details of both anterior and posterior approaches.

My recommendations? If you've got stenosis and any symptoms of myelopathy (you state exaggerated reflexes, which is an indication of myelopathy), you need to get it fixed. Don't put it off too long or you'll end up with permanent damage to the cord. As to the type of surgery - it really depends on the issues you have and the recommendations of the surgeon. Either of the approaches will probably fix the issue. Once you're fused, you're fused, while a laminectomy is not quite as drastic in that regard. If the laminectomy does not fix the issue, a fusion is always an option in the future. Neither of the surgeries is a walk in the park. I think you're going to have to decide based on which surgeon you trust the most and gives you the best explanation of how their procedure will fix the problem. It's not an easy decision, but in the end, I don't think there would be a great deal of difference.

Quality of life afterwards? It going to be determined on how much you allow some limitations to impact you. Personally, I choose to ignore my limitations as much as possible. I am still as active as I can be, doing all the things I did before as well as I can. My range of motion in my neck is less than before the first surgery. I have to be pretty careful about backing up the car and move more of my torso when looking to the side. I have difficulties looking up as well. I'm noticing that while doing some construction and decorating on our bathroom. Installing the shower plumbing fixtures and hanging the drywall and tile were more difficult tasks than before the surgery, and I sure am noticing it again while hanging the wallpaper. I still pop the occasional pain pill after overdoing it. But that's just the way it is, and I've got to deal with my new reality. I refuse to let my limitations be the driving force in the direction my life takes.

You're not alone - others have gone through your situation and have lived. I understand your fear and wish I could give specific advice on which surgery, but it really depends on your specific situation. I wish you luck with everything - keep us informed.

Hey moose, just what exactly is myleomalacia? It states on my last MRI post surgery, that i have granualization and /or myleomalacia at the area where i had a cavernoma removed.I am wondering what it is I am dealing with here.

Phil, moose has given you some really excellent advise .You do have a very difficult decision to make with regard to the confusing approaches from your docs.In your post for some reason the last part of what you were talking about with regard to not responding to pin***?is that the same as pin sticks?and what do you mean by that you don't respond to them/Do you mean that you cannot feel the pain sensation?just curious here so I have to ask, do you still respond to hot/cold sensations in that area or is that gone too/I have this same thing going on in my R side from just under the r breast and on down.Take an ice cold wash cloth and lay it on your leg or lower stomach and see if you feel the temp change.i didn't even realize that I had this going on until about three weeks after my surgery while in the rehab hospital.I was in too much pain in other places to even notice.It wasn't until I was giving myself a little bed bath when i went to wash the very sensitive upper thigh area and I knew that the wash cloth was arcticly cold so when i went to touch the area, I kind of braced myself for what was coming but much to my total surprise, when I touched my upper thigh with the wash cloth,I felt no cold sensation what so ever.I felt the sensation of the touch but nothing else.This is still the most bizarre thing about all of my nerve wierdness that seems to be the hardest to get used to.I also have to be very careful about being around like a grill or something or accidently leaning into a sharp object and definitely cannot go barefoot outside ever again.by the way, this is actually a syndrome called brown sequard syndrome.It is caused by damage to the thalamic tract in your spinal cord.I also have hyperreflexia X 3.I completely lost the c-7 reflex in the r arm but all my other reflexes are extremely hyper.The NS really watches it when he taps my knees now,lol.

I would discuss the reasons for the difference in the approaches that these drs want to do and see what they are and kind of go from there.I am so sorry that you have to go through all of this.it really sucks.Hopefully after talking with the docs your decision will be easier and not become even more confusing.please keep us posted here okay? good luck.Marcia

Myelomalacia is actually a "dead spot" in the spinal cord. In my case it was caused by too much pressure for too long a time - that kept the blood from keeping that section of the spinal cord nerves alive and well. The nerves in the spinal cord do not regenerate, so that spot is gone forever. It may be the cause of some of the pain in my lower back and may even be the cause of the foot drop I have (one of the nerves in my right leg just doesn't work anymore. The surgeons tell me they could run tests to find out for sure, but it wouldn't matter - there's nothing they can do anyway.

The moral is - if you've got myelopathy, get it fixed before permanent damage occurs.

I have to say that my feelings are to have the laminectomy, purely at this stage because it seems to be a much less traumatic procedure and a number of people (Gp, Chiropractor etc) have all told me to only allow a neuro surgeon to go anywhere near it! Also, I did feel a little more comfortable with him. The one thing stalling me though is the fact that the herniated disc is quite clearly at the front so, in some ways, it's not dealing directly with the problem. having said that, my aim from all of this is to be able to live a normal life without being paranoid that the slightest accident could have catastrophic results. If the laminectomy can achieve this (which the neurosurgeon seems to believe it will) then why go for the fusion! I am thinking out loud now! It is good to be able to bounce these thoughts off others who are or have been in the same situation though.

As for your questions feelbad, yes i do mean pin sticks. I can feel them put not as sharp as it should be and reaction to hot and cold is almost opposite! very strange. As far as I know these symptoms are a result of the accident and bruising of the cord and NOT from constant pressure on the cord. I will ask the question next time i speak to the doctor.

If your disc is herniated at the front, I would think that the logical approach would be to just have the anterior fusion,have the fusion and you will not have the risk of having to go back in for another surgery is the lamenectomy does not work.You still would run a small risk of the non fusion happening (it happened to me)but it would get rid of that bad disc forever.also,and I don't know just whether or not the recovery time is an issue or not or how bad the pain will be post op, but i have had two surgeries done from the front and one done posteriorly,and i can tell you that without a doubt, the first two surgeries done from the anterior were much less painful post op than the one from the posterior.Granted, the posterior one involved a three level lamy and a surgery done on the inside of my spinal cord but the muscle damage that I ended up with with regard to the NS just trying to get to the spine was pretty bad.You have much thicker muscle at the back of your neck than you do the front.I also ended up with so many huge tight knots up in the upper shoulder area that i am still having alot of problems with.it takes quite a while for that muscle and tissue to recover from the trauma of just being cut into.

you know, with regard to losing some of the spinal integrety,I would think that taking off the back of part of a vertebrae as opposed to leaving them intact and just removing the disc and having a fusion done to join those two vertebrae would leave you with much better integrity than removing that part of a bone forever.You could also have a plate and screws placed that would ensure a good fusion(that is entirely up to you).It just makes more sense to me,just my opinion.hope you can arrive at a comfortable decision.I know that anyway you look at it, surgery just sucks.

I just wanted to mention that i too feel almost an opposite reaction to the hot/cold too.when i get into a really hot bath tub,it feels like I am taking a bath with a giant ice cube,and during the winter if I had to take a quick run outside for some reason,it almost felt like from the mid back and down,on the R side, I was actually generating some kind of heat.Isn't it just a trip to try and explain this to other people?(let alone,try and live with it)I know when I have tried to explain things to people about just what happens with that right side, the really totally confused looks on their faces is rather fun to watch,lol.It is so hard to explain that I cannot feel hot or cold or surface pain but if you took something as light as a feather and ran it over my skin, i can feel that.The way the nerves are is truely amazing.i never realized just how many totally strange and bizarre sensations were possible for your nerves to create.and the pain syndromes are just hidious.Unfortunetly i have two different types of nerve pain syndromes.Well keep me up to speed on what you decide.good luck,Marcia

Well, after much consideration I have decided to go for ACDF with Plate & Screws. All booked up for 4th August! I feel so relieved just to have made a decision. Thank you all for your help and advice... I'll let you know how I go!